Recent advances in the pharmacological management of migraine

Pharmacological treatment of migraine includes acute and, in some patients, preventive medications. Here, the most relevant recent advances in migraine management are reviewed. Regarding acute treatment, new data indicate that early treatment of migraine attacks should be recommended to those patients who do not show a clear response when pain is already moderate or severe. It has also been shown that, in terms of efficacy, the combination of a nonsteroidal anti-inflammatory drug plus a triptan is superior to monotherapy. In the immediate future it seems that a new class, the antagonists of calcitonin gene-related peptide, will offer at least the same efficacy as that of potent triptans, but a much better tolerability and no vascular contraindications. Concerning migraine prevention, news has been concentrated on the management of chronic migraine, with the appearance of guidelines for clinical trials in chronic migraine and the demonstration that it is a treatable entity, even in the presence of overuse criteria.